1/5. fascioliasis observed during laparoscopic cholecystectomy.fascioliasis is an uncommon zoonotic disease caused by fasciola hepatica, a liver fluke, for which humans act as an accidental host, infected by the ingestion of water or raw aquatic vegetables contaminated with the metacercaria. We report the case of a patient who presented to our clinic with right upper abdominal pain and nausea. physical examination and abdominal ultrasonography revealed cholelithiasis. Peripheral blood eosinophilia was the only positive sign observed during routine laboratory tests. We therefore decided to perform laparoscopic cholecystectomy. During laparoscopy peritoneal implants approximately 0.5-1 cm diameter were detected which gave an impression of peritoneal carcinomatosa. Laparoscopic cholecystectomy was performed, and biopsies were taken from the peritoneal implants which were examined histopathologically, and fascioliasis was determined.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
2/5. Obstruction of common bile duct caused by liver fluke--fasciola hepatica.Three cases of obstruction of the common bile duct by fasciola hepatica with two of the patients presenting jaundice are reported. The authors have reviewed several publications concerning common bile duct obstruction by liver fluke, a quite rare complication of fascioliasis. Only nineteen cases of common bile duct obstruction caused by fasciola hepatica have been reported in a review of medical publications during last ten years. Clinical presentation, diagnostic methods and considerations, types of surgery are fairly uniform in all of the reported cases. Almost all of patients reviewed, had the history, symptoms and signs characteristic for cholelithiasis including recurrent colic pain in right hypochondriac area, fever or subfebrile temperature, fluctuating or stabile jaundice, and palpable painful gallbladder. The laboratory findings in all cases reviewed had shown leucocytosis, eosinophilia, high or slight elevated serum bilirubin. Echographically commonly revealed dilated intra- and extrahepatic bile ducts containing one or more hyperechogenic elements with or without casting an acoustic shadow. All patients underwent open surgery, comprised with choledochotomy and if possible extraction of the fluke. Only two postoperative cases were of necessity followed by ERCP. In all of our cases the primary pre-operative diagnosis was choledocholithiasis, with diagnose of fascioliasis established at the operation. According to the literature this uncertainty in diagnosis is common because of difficulties in differentiation of fascioliasis versus choledocholithiasis. Considerations for making the differential diagnosis--a history of origin or visiting in endemic area of infection, history of eating of aquatic vegetables, laboratory findings including eosinophilia, fasciola eggs in stool, sonography and radiological imaging results and enzyme-linked immunosorbent essay (ELISA) which has been shown to be rapid, sensitive and quantitative. In all three cases we have observed intraoperative significant signs for liver fascioliasis to include surface scarring of the left lobe on the liver--tracks caused by subcapsular migration and location of the hepatic lesions (these findings were also seen by two authors in literature) with resemblance to Japanese letters. The most effective drug for treatment of fascioliasis according to our experience and literature reviewed is bithionol.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
3/5. Uncommon complications of human fascioliasis in Alexandria.fascioliasis is becoming more frequently discovered among citizens of Alexandria. The main presenting clinical manifestations including hepatic pain, colics, fever, anorexia, discomfort with meals and hepatomegaly. We select here 4 cases with unusual presentation from patient's record of the last year: one case developed liver abscess due to F. hepatica infection. Two cases were encountered during cholecystectomy in patients suffering from cholecystitis with cholelithiasis; in one of them the gall bladder had ruptured and the patient developed an abscess in the liver related to the gall bladder bed. In both cases F. hepatica worms were found in the bile duct. The fourth case presented with acalcular cholecystitis with empyema of the gall bladder.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
4/5. biliary tract disease due to fasciola hepatica: report of a case.We report a case of a 23 year old woman who presented with symptoms of biliary tract disease to our University Hospital in Bayamon, puerto rico. A diagnosis of chronic cholelithiasis was made and the patient was taken to surgery. An adult fasciola hepatica was recovered from the common bile duct. We review the pathobiology of this uncommon zoonosis.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
5/5. hemobilia and liver flukes in a patient from thailand.A patient from Southeast asia presented with abdominal pain, fever, jaundice, and upper gastrointestinal bleeding of unknown origin. opisthorchis viverrini eggs were found in the stool and multiple hepatic filling defects were noted on liver scan and sonogram. Endoscopic retrograde cholangiopancreatography revealed cholelithiasis and crescent-like filling defects in the biliary system. At surgery, the gallbladder was filled with clotted blood and pigmented stones. During T-tube drainage of the common bile duct, small elliptical flukes (4 X 3 mm) identified as O. viverrini were recovered. Despite adequate biliary drainage, the patient continued to have high fevers. On the 53rd postoperative day, a larger fluke (2.8 X 0.8 cm) identified as a fasciola hepatica migrated down the T-tube. Institution of therapy with bithional resulted in complete clinical resolution within 3 wk. Six years later the patient returned with fever, jaundice, and right upper quadrant pain. Two large pigmented stones were found in the common bile duct and were removed after endoscopic sphincterotomy. The stones had developed even though there was no evidence of recurrent helminthic infection.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |